Pueblo Community Health Center Inc

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

180635 Issued in CO

Legal business name

PUEBLO COMMUNITY HEALTH CENTER INC

Practice address

129 Kansas Ave
Walsenburg, CO 81089-1818

Phone

(719) 738-2718

Fax

(719) 738-2732

NPI assigned

Nov 14, 2007

Last updated

Sep 30, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Donald Moore

Title

Ceo

Phone

(719) 543-8718

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Walsenburg Clinic Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790966174. Details of each certification follow.

• CCN 061898 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 061898

Legal name

PUEBLO COMMUNITY HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Apr 1, 2008

Last certification

Apr 1, 2008

Ownership / control type

For profit – partnership

Facility address

129 Kansas Avenue
Walsenburg, CO 81089

Related CCNs

061830

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632960000000",
    "number": "1790966174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E ROUTT AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810042117",
            "telephone_number": "719-543-8711",
            "fax_number": "719-585-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 KANSAS AVE",
            "city": "WALSENBURG",
            "state": "CO",
            "postal_code": "810891818",
            "telephone_number": "719-738-2718",
            "fax_number": "719-738-2732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUEBLO COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-14",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "719-543-8718",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CO",
            "license": "180635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05638275",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walsenburg Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Walsenburg Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• C David Neece, D.O.
• Phil Warlick, DDS, Inc
• Poudre Valley Medical Group, LLC (UCHealth Medical Group)
• Poudre Valley Medical Group, LLC (UCHealth Medical Group)
• Pueblo Community Health Center Inc (Pueblo Community Health Center)
• Pueblo Radiological Group, P.C.
• Qualicenters Pueblo, LLC (Qualicenters Walsenburg)
• Rocky Mountain Clinics LLC
• Sangre de Cristo Community Care
• Barbara Jean Sargent, CCC-SLP

• Federally Qualified Health Center (FQHC) in Walsenburg, CO
• Providers in Walsenburg, CO by specialty
• Federally Qualified Health Center (FQHC) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.